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Press Briefing Transcript

Measles Press Conference: 50th Anniversary of Measles Vaccine

BARBARA REYNOLDS: I'm Barbara Reynolds, director for public affairs here at CDC and we're going to begin in one-minute following a brief video.

VIDEO: Disease knows no borders. They travel quickly, broadly and quietly. Creating a perfect storm of vulnerability. CDC works around the world 24/7 as our nation's front line of defense from threats. Counted on to identify outbreaks and stop them, to find out what works to protect health and put science into action. America's next health threat could arrive from anywhere. CDC is ready 24/7.

BARBARA REYNOLDS: Good afternoon and welcome to CDC's media briefing to mark the 50th anniversary of the measles vaccine, to provide an update on the measles here in the U.S. and worldwide and to discuss the threat measles importation and other infectious diseases pose to our national health security. CDC works around the clock and around the globe to protect people from health threats. Before I introduce our speakers, I would like to welcome those of you here in the room and those joining us by phone. I would especially like to welcome international media and others who are joining us through a live webcast. Following brief remarks from our speakers, we will take questions on the topic from media in the room and on the phone. The briefing will conclude with a special presentation from CDC to Dr. Katz.

And now to introduce our speakers, Dr. Tom Frieden, the CDC director, will address the spike in imported measles in the U.S. and the global health security concerns posed by infectious diseases. Next, Dr. Peter Strebel, the Accelerated Disease Coordinator for Immunization, Vaccines and Biologicals at the World Health Organization will speak on global measles elimination. And then Dr. Alan Hinman, the Director for Programs with the Center for Vaccine Equity at the Task Force for Global Health and also a former CDC center director for National Prevention Services will speak on the profound differences the measles vaccine has made in the health of children. And our special guest today is Dr. Samuel Katz, Wilburt Cornell Davison professor and chair emeritus of pediatrics at Duke University and the co-inventor of the measles vaccine. Dr. Frieden?

TOM FRIEDEN: Thank you very much and thank you all for being here. I welcome in particular to Drs. Katz, Strebel and Hinman. We're delighted to have you here and honored, Dr. Katz, that you've joined us. In my very first month as a CDC employee nearly 25 years ago, I was dealing with a very large outbreak of measles in New York City. It was affecting hundreds of kids. It was spreading in emergency departments and communities. It was affecting kids who were too young to vaccinate. I began to get the respect that all of us should have for the devastation that measles does and can cause. It is probably the single-most infectious of all infectious diseases, and it is capable of taking out whoever is susceptible from even a very large crowd, if there's a single infectious patient.

Now, 50 years ago, Dr. Katz and his colleagues created the measles vaccine, and that vaccine has been one of the great accomplishments not only of science and medicine, but of human kind. A simple tally suggests that over the past 50 years, 30 million children as a minimum, at least 30 million children, survived who would have been killed by measles. That's an astonishing number. Even today over the past ten years, there's been big progress in reducing childhood deaths. In fact, the world is just about on track to meet the millennium development goal of drastically reducing childhood deaths by 2015. And the largest single component of that decrease, about a quarter, is the reduction in measles deaths. But it is not a finished success story. It is dramatic progress, remarkable progress, demonstration of what can be achieved, but we are not anywhere near over the finish line.

We have a new study out today in JAMA Pediatrics that shows that not only did the U.S. and this entire hemisphere eliminate measles ten years ago, but we've been able to maintain elimination for a full decade. Elimination, though, is not eradication, and as long as there is measles anywhere in the world, there is a threat of measles anywhere else in the world, and that's the case here as well. We have seen an increasing number of cases in recent years coming from a wide variety of countries. Over the year we've had 52 separate known importations with about half of them coming from Europe, where a very large number of U.S. travelers go and return. We have seen a spike this year, 175 cases and counting as of November 30th. Nine outbreaks, including three large ones in New York City, North Carolina and Texas, 20 hospitalized cases. And if you look at all of the cases that we have described in detail, less than two percent were fully vaccinated against measles.

So the disease is remarkably infectious, but the vaccine is remarkably effective. And that tells us that we can continue to make substantial additional progress. You'll hear from our colleague, Dr. Strebel, about the 20 million or so cases of measles around the world and continued death toll that goes to about 400 measles deaths per day around the world. So it is a tremendous success story, but an unfinished success story. Now, there are three elements of a successful measles control program. The first is that first dose coverage has to be early, high and sustained. You have to get that first dose in. The second is that everyone needs a second dose. This is something we learned with time. And the third is that surveillance has to include rigorous laboratory confirmation and genetic analysis to identify the trends by which measles is spreading so that we take appropriate action.

Now, just to spend a moment thinking about some of the lessons that measles and measles vaccinations teach us, one is, of course, that we're all connected by the air we breathe, by the water we drink, by the food we eat. And just as any virus anywhere is only a plane ride away, measles anywhere is really potentially the cause of an outbreak here, as we've seen substantially in the past year. Pathogens cross borders effectively, and that's why we need to improve further on our support and partnership with the World Health Organization and with countries around the world to better find, stop and prevent threats to health. That will make for a safer United States and a safer world, because we really are interconnected.

In order to do more in terms of finding, stopping and preventing, we need some core capacities to increase the ability of governments and society to recognize, respond and bounce back, to increase resilience. For detection, we need laboratory networks. For response, we need effective emergency operation centers that can scramble in real time and marshal people who can create a rapid response team and stop an outbreak. And for prevention, we need to be able to get high levels of vaccination and respond to outbreaks effectively to stop them and prevent other threats to health from emerging. Unfortunately, the vast majority of the world does not yet have these capacities fully developed, but fortunately there is a global commitment to do so, and I am very optimistic that in the coming years we'll see substantial additional progress, not only with measles, but also with our general ability to find, stop and prevent not only measles, but also other health threats. So I’m delighted to have our visitors here and turn it back over to Barbara Reynolds.

BARBARA REYNOLDS: So next is Dr. Strebel, and he'll be speaking global measles elimination. He leads the measles program at the World Health Organization in Geneva and has worked for more than 15 years in U.S. National Immunization Program, including here at CDC. Dr. Strebel.

PETER STREBEL: Thank you. The 50th anniversary of measles vaccine is indeed a time to celebrate the global impact of this highly effective vaccine. Worldwide use of measles vaccine has led to a greater than 90 percent reduction in measles deaths, and that's down from the more than 2 million measles deaths that occurred each year during the pre-vaccine era. In addition, all countries in the Americas have eliminated measles since 2002 and rubella since 2009 through the use of combined vaccines. So because of the success the global vaccine action plan now targets measles elimination, together with rubella elimination in five of the six world health organization regions by 2020. The vision of a world without measles, rubella and congenital rubella syndrome has been taken out by The Measles and Rubella Initiative. The five-core partner organizations in this initiative, the American Red Cross, the U.S. Centers for Disease Control and Prevention, United Nations Foundation, UNICEF and the World Health Organization use complementary strength to support vaccination and the new surveillance efforts. Since 2001, The Measles and Rubella Initiative has supported vaccination in 60 countries, reaching more than one billion children, and developed a global laboratory network for the diagnosis and identification of both measles and rubella viruses. Recently the GAVI alliance has joined the fight against measles and rubella by committing over $750 million to support low income countries.

However, despite this progress, measles remains a formidable enemy and recent setbacks have included outbreaks of measles in developing countries such as Nigeria and Pakistan, where immunization systems are weak, as well as outbreaks in industrialized countries, for example in Western Europe, due to misconceptions about vaccines. These outbreaks are leading to greater political commitment and community acceptance of vaccination. The success of current efforts to eliminate measles will depend on country commitment to develop strong immunization programs and resource mobilization at all levels, including by international partners. With this kind of commitment, we can achieve the vision of a world without measles, rubella and congenital rubella syndrome. Thank you.

BARBARA REYNOLDS: Thank you, Dr. Strebel. And next we have Dr. Alan Hinman, who's been involved in public health programs at the state, national and international levels since 1965. He served as director of CDC's Immunization Division and director of CDC's National Center for Prevention Services. He directs today the vaccine programs at the Task Force for Global Health. Dr. Hinman.

ALAN HINMAN: Thank you, Barbara. As Dr. Frieden said, measles is one of the most highly infectious agents that we know. It is so infectious, that before vaccine was available, essentially every child in the United States had measles before the age of 15. That means that every year on average we had around 4 million cases a year. However, only about 400,000 or 500,000 of them were reported, because measles was viewed as a relatively minor problem. It was not really a minor problem, however, because these kids were sick and they transmitted disease to others. And every year before vaccine was available, even in the modern era of antibiotics, every year we had between 450 and 500 deaths in the United States due to measles.

This is a severe problem, as mentioned. Globally we had more than two million deaths a year before measles vaccine was introduced so the accomplishments in isolating the virus and then the further work by Dr. Katz in weakening the virus in the laboratory to make it into a vaccine that could be used are really very significant achievements. Through the use of the vaccine, the annual number of measles cases in the United States dropped from the estimated 4 million plus a year down to just a few thousand. In the year 2000, Dr. Katz chaired an expert committee meeting which participants concluded that measles had been eliminated from the United States, and elimination means that there's no longer continuous transmission throughout the year.

There may be cases of measles, but they all are attributable to a source from outside the U.S. and since this elimination was declared, we've averaged about 60 cases a year. As Dr. Frieden mentioned, we’ve had a resurgence in 2011 and again a little bit in this year. It's really nice to be worrying about 175 cases of measles. You know, it's a mark of progress, but it also shows how much further we have to go. In 2011, an expert panel was convened and concluded that elimination had been maintained and that's the article that Dr. Frieden mentioned that has just been published today. However, we still have gaps in the United States. In 15 states in the country, at least 10 percent of children have not received measles vaccine by the time they're three years of age. And we are seeing clusters of unvaccinated people, particularly clusters of people who reject vaccination. This clustering leads to localized outbreaks when measles is imported into the United States. So we have made a lot of progress. Measles is no longer a native disease in this country. But it is a foreign visitor and we need to try to ensure global eradication in order to continue to protect ourselves. Thank you.

BARBARA REYNOLDS: Thank you, Dr. Hinman. And now Dr. Samuel Katz, the pioneer in the prevention of infectious diseases and in collaboration with Nobel Prize winner Dr. John Enders created the measles vaccine. He currently serves as the professor and chair emeritus of pediatrics at Duke University Medical School, is co-chair of the National Network for Immunization Information, and is an editor of the textbook Infectious Diseases of Children which is used around the world as a standard text on the subject. Dr. Katz.

SAMUEL KATZ: Thank you very much, Barbara. It's a little bit humbling to be fitted at an occasion such as this, and I would like to point out very quickly that developing a vaccine can be very fulfilling and very exciting, but if it just sits in the refrigerator in a vaccine vial, that doesn't do much for anyone. And I think the people who deserve congratulations and adulation are the people out there in the trenches. The people who are taking the measles vaccine into Mozambique, Pakistan, Afghanistan, Bangladesh, into those parts of the mainly resourced poor countries in sub-Saharan Africa where measles is still killing millions of children each year. It is possible to eliminate measles even in these countries. I think one of the most remarkable achievements was eliminating polio from India, where no one thought it could ever be done. But with great efforts by the government, by the workers in the trenches, polio has been eliminated from India. Whereas it used to be three countries, polio was in Afghanistan, Pakistan and Nigeria. Now you scratch Nigeria off the list. And the two countries where measles -- excuse me, where polio has never been eliminated are remaining in Afghanistan and Pakistan.

Now, there are features of measles vaccine which are being improved. It's 50 years and we're pretty much using the same vaccine in the same way as we did in 1963. But even here at CDC, as I learned very excitingly in my visit here in the last two days, there are efforts to make measles vaccine much more easily applied in the field. One, the use of aerosol and droplets has been experimented and used with differing results in different countries. But to me the most exciting is the approach to using micro needles, little patches that you put on the arm of the recipient, leave for a little while and then remove. Not a needle, not an injection, not a syringe, not a lot of material to be prepared and discarded afterwards. And I’m hopeful that we'll see that before the next anniversary of measles vaccine. The people who were out there in the field, as I mentioned, are the ones who really deserve the credit. The ones who are out there every day, mobilizing children and their parents to apply measles vaccine. I don't have to remind you of some of the terrible things that have happened in the last couple of years with actual assassination of vaccine administrators, mainly polio, but also measles in northern Nigeria. So these people aren't just putting themselves on the line for doing extra work, their lives are at stake. And I think we need to congratulate and admire them in every way.

Finally, we've talked about the families with hesitancy about vaccines, principally in the United States, but also in Western Europe and other parts of the world. I don't think we're ever going to change their minds. These are people who are very rigid in their approaches. However, it's important to realize, as has been pointed out by the previous speakers that if you can get 95 percent of children immunized against measles, those others will probably be protected passively. You will have no spread of virus among the other children in the state, the county, the country, wherever you're speaking of. So again, I’d like once more to emphasize that it's the administrators, it's the people in the trenches, it's the people who are doing the work that deserve your adulation and your praise and not the guys who sat in the lab and had a good time developing the vaccine. Thank you very much.

BARBARA REYNOLDS: Thank you, Dr. Katz. And now we're going to open it up for questions from the media. I invite media with questions about today's topic and other topics to call the press line. But before I start, I want to also have the operator tell them to give the direction to the operators. Calvin -- I mean to the media on the phone. He might be doing that and we're not hearing it, I’m not sure. Okay. So why don't we go ahead and take a question from the room. Mike from AP, I understand that we'll be giving names and affiliations.

MIKE STOBBE: Okay--Mike Stobbe from the Associated Press. I had a number of questions. First of all, of the count this year, were there any deaths?

TOM FRIEDEN: No deaths this year. We've had about 20 hospitalizations.

MIKE STOBBE: Okay, thank you. Second, Dr. Hinman was talking about that there were at one time four million cases, I think, a year but just a fraction of those were reported.

ALAN HINMAN: Right.

MIKE STOBBE: Are we confident that the 175 is a complete picture or do you think that's -- how many cases do you think actually there are?

ALAN HINMAN: This has been -- actually this has been studied, and it's not 100 percent of the cases. On the other hand, when we learn of a case of measles and go out to investigate it, it's uncommon that we find cases that occurred beforehand that we had not heard of. It does happen. I think probably estimates of the completeness of reporting in the U.S. now would be on the order of 70 percent to 80 percent.

TOM FRIEDEN: The fact that there are cases which we cannot identify the non-U.S. source; those are kind of indications that there are some cases perhaps that haven't been diagnosed or reported. And measles is a spectrum of illness, so some of the more non-severely ill kids may not be diagnosed or reported.

MIKE STOBBE:Okay. I'm sorry, last one. This could be a follow-up later. But I was wondering how you got the estimate about 30 million lives saved.

TOM FRIEDEN: We can give you the information.

MIKE STOBBE: Okay, thank you.

BARBARA REYNOLDS: Okay. Next question.

DIANA DAVIS: It’s Diana Davis from WSB here in Atlanta. For Dr. Frieden, can you just reiterate again, because this is what's of particular interest to my viewers, those people that did get the measles in these clusters, was it their resistance to the vaccine or was it more their lateness with the vaccine or a combination of both?

TOM FRIEDEN: Really what we're seeing with the measles cases in this country is a combination of two things. First, continued spread and in some cases resurgence of measles around the world, reminding us that we are all connected by the air we breathe. And second, it is not a failure of the vaccine, it's a failure to vaccinate. So around 90 percent of the people who have had measles in this country were either not -- were not vaccinated either because they refused or not vaccinated on time. Everyone, all kids at age 12 months should be vaccinated and revaccinated at four to six years of age. Travelers who go to a place where there is measles should have infants age six months and over vaccinated.

DIANA DAVIS: Just a follow-up. Do you think that it was -- your data shows that it was more of that resistance to vaccine because of fear or because, oh, I forgot or, gee, I didn't have time to get to the doctor for that second dose?

TOM FRIEDEN: Particularly in the large outbreaks that we identified, it was religious or personal exemptions where people had declined to be vaccinated.

MICHELLE ELOY: Hi. Michelle Eloy from PBA. I don't know if this is a reiteration of her question, but that foreign sources would be bringing measles into the country isn't necessarily anything new, but the number seems to have gone up pretty quickly to 175. So what would contribute to that rapid rise in the United States?

TOM FRIEDEN: Measles traditionally has a cyclicity every three years of seeing a resurgence. The theory is and Dr. Strebel and Dr. Hinman can certainly talk more meaningful about this than I can, there's a buildup of the number of susceptible children that allows a critical threshold that allows measles to spread. And we have seen in recent years a resurgence of measles in some other countries and we're seeing essentially the echo or reflection of that here.

ALAN HINMAN: I would just add that it's also the case that the number of importations into the United States is probably fairly constant. The difference from year to year is in how much spread there is after the case arrives in the United States. We've seen particularly among clusters of people who refuse vaccination, we've seen significant spread. You need to realize that we consider an outbreak of measles to be three or more cases that are related. This is, again, a mark of the progress that's been made.

SAMUEL KATZ: I want to point out one thing and that is Peter can give you data better than I, but we're not talking about measles being imported from Bangladesh and from India and from the resource poor countries. Western Europe has had 25,000 cases of measles every year for the last three years. And again, in great part due to vaccine hesitancy. I hesitate to use the word "refusal" because I don't think it's always a fear, it's a hesitancy on the part of some parents. And so the cases that we're seeing now, which CDC takes the lead, Bill Bellini, Paul Rota, people in their lab can tell you where it comes from because they can study the genotype and show that we're getting cases from the United Kingdom, from Spain, from France, not just from the resource poor countries, so that the failure to eliminate measles in these countries has been a critical part to the importation into the United States.

PETER STREBEL: I just want to add there I think that we have seen that large outbreaks in other places outside the U.S. do result in importations, yeah, and the surveillance system in the U.S. actually picks these up. And so there's clearly a need to control measles worldwide because it's a frequent flier on pretty much most of the airlines. So I think this link is clearly seen.

BARBARA REYNOLDS: Okay. Next question, please.

ERIN SYKES: Erin Sykes with NBC news channel. It seems the headline coming out of today is that measles is eliminated, remains eliminated in the U.S. but in the next breath we're saying we saw a spike in cases so for viewers at home I think that could be a little confusing to them. They might not understand the technical definition of elimination. So if we can maybe go over that or perhaps explain an easier way to explain that to our viewers. Secondly, you mentioned around two percent of fully vaccinated patients did come down with measles. Is that the average failure rate or were there other factors that play there?

ALAN HINMAN: Well, first, with respect to the definition of elimination, we define elimination as no continuing transmission. So a period of 12 months in which there has not been continuing transmission of measles. We see importations of measles from other countries and it may be limited spread. But in order to claim elimination, that spread has to last substantially less than a year. And typically in the U.S. it lasts for a matter of six weeks, eight weeks, and then dies out because we have such high levels of immunity in the country. With respect to vaccine failure, with two doses of measles vaccine, 95 percent or more of children will be protected against measles. And there is a failure rate, as there is with every vaccine. Often this is due to causes that we have no idea that we don't understand.

TOM FRIEDEN: In terms of your first question, measles only occurs in people. It does not continue to spread in the U.S. so the spread of measles within the U.S. stopped ten years ago and has never continued to come. What we have had is people coming into the U.S. or visitors from the U.S. going and visiting, getting infected and coming back and causing little clusters. Think of them as kind of small-scale outbreaks where there is a little bit of local spread, but it stops because of the force of immunity in the population. But the elimination means that there is no indigenous or native measles continuing to spread in the U.S. or in fact in this hemisphere or rubella for that matter.

BARBARA REYNOLDS: Okay. Calvin, could we take some calls from media on the line, please?

LIZ SZABO: Hi. I was just wondering what the threat of measles will be given the travel to the Olympics and other world travel events coming up, and what sort of advice you would give people. I think most of us only receive one shot of measles when we were kids. Most of those who were adults -- should adults get a booster? So in general, what is the threat of measles in international travel and how should people protect themselves if they were traveling?

PETER STREBEL: Thanks. Well, the World Health Organization recommendations are very clear here that travelers should ensure that they have had two valid doses of measles before they travel. This is a strong recommendation, but it's not a requirement. I think that the real challenge is in having to enforce something like this. But I think there is a high degree of awareness of the need particularly, for example, in the western hemisphere with the World Cup happening next year. The whole hemisphere is free of measles, so the Pan American Health Organization is doing a lot of work with the teams that are going to come for that world event to ensure that the players, managers and their fans are vaccinated before they actually come. I think this is a key issue really of getting that message out that all travelers, regardless of age, should check their vaccination status and ensure they have had two doses of measles vaccine.

TOM FRIEDEN: Unless they were born before 1957, in which case they have natural immunity because virtually everyone got infected. It's particularly important for infants age 6 to 12 months to get vaccinated because we don't recommend vaccination in this country in that age group. So if you're taking a 6 to 12-month infant overseas, you may need to get them vaccinated.

BARBARA REYNOLDS: We have time for one more question on the phone, please.

OPERATOR: The next question comes from Robert Lowes from Medscape Medical News. Your line is open.

ROBERT LOWES: Yeah, thanks for taking my call. There is an editorial accompanying the article in JAMA Pediatrics where the author, Mark Grabowski says the greatest threat to the U.S. vaccination program may now come from parents' hesitancy to vaccinate their children. Dr. Frieden, do you agree with this statement? And I'd be interested in hearing the reaction of other speakers today on that.

TOM FRIEDEN: I think vaccination requires continuous effort, children continue to be born, we continue to see concerns and in some cases rumors about vaccines. Unfortunately, we have had some inaccurate information about vaccination circulated and so we do think it's a significant threat. In some ways vaccination becomes a potential victim of its own success because the diseases that we're vaccinating for are no longer so common in this country, it can lure us to a sense of complacency, but measles can be deadly. It's a serious disease. And we need to both ensure that we keep our own guard up and work with WHO and partners around the world to drive numbers down around the world to protect not only those countries but ourselves as well.

SAMUEL KATZ: I think one of the phrases that I have seen repeatedly is we live in a borderless world. There's no border between Mumbai and India and San Francisco airport or New York's La Guardia or Idlewild airport. It's so easy for someone to come and measles incubation period can be 10 to 14 days. Most flights take less than one day to get from an endemic area to the United States, so I agree with what my colleagues have said. One point I'd like to emphasize with which a number of other countries disagree, but we have such a high rate of immunization because most schools require vaccinations before you go to school at kindergarten or first grade. Not just measles, but among them measles. A lot of people feel this is unethical or it's an abridgement of the freedom of rights. I'm a strong supporter of the fact that part of the reason we have done so well is because we have school entry requirements.

ALAN HINMAN: If I could just pick up on that, the Supreme Court has, in fact, held that school immunization requirements are constitutional, so it is not a denial of constitutional rights. It's a reflection of the fact that communities feel that it's important for children to be protected. We used to have a lot of outbreaks in school settings. But all 50 states have enacted state requirements. This is not a federal requirement for children to be immunized before entering school. And to add on to Dr. Katz' comment that school immunization requirements are heavily responsible for our great success, I would add a second ingredient which I think has been potentially equally as important and that's the Vaccines for Children Act which provides vaccines as an entitlement to children who are uninsured, underinsured, on Medicaid or are Native American/ Alaska Natives. And Vaccines for Children Programs accounts for about 50 percent of all the childhood vaccines administered in the United States. This has taken the barrier -- any financial barrier away from ensuring that poor kids get immunized.

BARBARA REYNOLDS: I'm sorry, could I please now have Dr. Katz and Dr. Frieden join me here. And Dr. Martin.

TOM FRIEDEN: So it's a privilege to share the podium with Dr. Katz. A friend of CDC and a world leader in the study and prevention of not only measles but other infectious and childhood diseases as well. Not only has Dr. Katz worked on measles, but he's also worked on vaccinia, polio, rubella, influenza, pertussis, HIV, and many other things that our kids don't want to get. He's also been a chair of the Advisory Committee on Immunization Practices at CDC, or ACIP. ACIP is really a model for open, transparent decision-making where all of the information is openly and objectively presented. Consumer as well as provider and interest groups of all kinds. All views are heard and then the decision is made in an environment of openness. And that is something that Dr. Katz has done.

He's also been chair of the Infectious Disease Committee of the American Academy of Pediatrics and too many other committees for me to mention. He's also been a mentor and inspiration for many of us here at CDC. As we heard, literally millions of people are alive today because of the work that he and his colleagues did on the measles vaccine. Before the vaccine was available, there was a saying in Nigeria, “don't count or name your child until measles has passed.” And that has changed so much. When smallpox eradication efforts were under way in Africa and smallpox was getting less and less common, people were getting less and less interested in getting the smallpox vaccine, but they remained acutely interested in getting the measles vaccine because they saw people getting ill and dying from measles, and having severe post-measles complications as well.

So the measles vaccine has been called the tugboat that helped get smallpox over the finish line. And I think it may have the same effect in our efforts to get Nigeria and other countries over the finish line in terms of polio. Also you heard Dr. Hinman mention the Vaccines for Children program. I mentioned it when I started at CDC there was a large measles outbreak. In fact that outbreak was the genesis of the Vaccines for Children program which this year is experiencing its 20th anniversary, 30 years younger than the measles vaccine. Took us a while to make sure all kids got it. But as Alan said, it's about half of all childhood vaccines. And the VFC program is a great example of what we can do to reduce inequalities in health because they basically eliminated virtually all differences in vaccination rates among kids and that's great for everyone, because it reduces the spread of disease. So I really do want to thank Dr. Katz. You know, IRB’s and such were a little different 50 years ago, so Dr. Katz and his colleagues, to prove that the measles vaccine was safe, injected it into themselves, so he's well protected against measles. And he's taken that message that vaccination is life-saving around the world. So it gives me great pleasure to give this plaque to Dr. Katz on the occasion of the 50th anniversary of measles vaccination.

SAMUEL KATZ: Thank you, Tom. In accepting this, I would quickly point out, as I have repeatedly; I'm only one of a group of people. John Enders, who you've heard mentioned, Milan Milovanovic who was from Yugoslavia, these were the other two who were instrumental in our work in the laboratory. I'm fortunate that I'm the survivor. The other two have passed away. But I would like to be certain that they are remembered as you think about the genesis of the vaccine. Thank you, Tom.

TOM FRIEDEN: Thank you. [ applause ]

BARBARA REYNOLDS: Thank you. This concludes the media briefing and I invite media with questions about today's topics or other topics to call CDC's media line at 404-639-3286. Thank you.